治疗性血小板单采术在血小板增多症患者中的应用

摘要

Objective To observe the therapeutic effect and adverse reactions of therapeutic platelet-phoresis in thrombocythemia. Methods 33 patients with thrombocythemia were subjected to therapeutic plateletphoresis (17 cases with primary thrombocytosis and 16 cases with chronic myelocytic leukemia complicated thrombocythemia) by automatic blood cell separator. The number of platelet was 818 ~ 2 230 × 109/L before plateletphoresis; 28 patients was repeated twice and 5 patients was repeated three times at intervals of 2 ~ 3 days. The ratios were 1:8 ~ 11 between ACD- A and whole blood. The blood flow rate was 40 ~ 65 ml/ min. The proportion of collected platelets to circular platelets was 40% ~65%. Vital signs, overdose reaction of ACD-A and obstruction of separation channel were measured during treatment. Hydroxycarbamide was given to patients after plateletphoresis and blood platelet count rechecked after one month. Results Platelets were collected from peripheral blood that the volume of blood flow was 5 549 ~9 195 ml and the concentrated platelet volume was 398 ~614 ml. The platelet count was 208 ~522 × 109/L in patients after plateletphoresis. However,the platelet count rebounded to 590 ~ 668 × 109/L in 5 patients with primary thrombocytosis after one month. The life signs of the patients were stable and the separation channel was during the procedure of plateletphoresis with mild adverse reactions. Conclusion The therapeutic plateletapheresis was ive, rapid, safe and adjunctive therapeutic tool in thrombocythemia. The female patients were easy to present the ACD-A overdose rection.%目的 观察治疗性血小板单采术对血小板增多症患者的疗效和不良反应.方法 应用德国产HemoTec 全自动血细胞分离机对33例血小板增多症患者(原发性血小板增多症17例,慢性粒细胞白血病继发血小板增多症16例)进行治疗性血小板单采术.单采术前血小板计数818 ～2 230×109/L,33例中28例进行2次单采术,5例进行3次单采术,间隔2～3d.抗凝剂为枸橼酸-葡萄糖抗凝溶液A(ACD-A),其与全血比例为1:8 ～11,全血流速40 ～65 ml/min,收集血小板比例占循环血液中血小板的40％ ～65％.单采过程中监测患者生命体征、观察ACD-A过量反应、分离套件是否堵塞等情况.单采后口服羟基脲治疗,1月后复查血小板计数.结果 每次单采后收集血小板悬液体积398 ～614 ml,采集血容量5 549 ～9 195 ml.血小板单采术后患者血液循环中血小板计数为208～522×109/L,1月后复查血小板计数示5例原发性血小板增多症患者明显反跳,至590～668×109/L.分离单采过程中,不良反应轻微,患者生命体征稳定,分离套件未发生堵塞情况.结论 治疗性血小板单采术对血小板增多症患者的疗效确切、快速、安全,是血小板增多症的一种重要的辅助治疗手段.女性患者易发生ACD-A过量反应.